Provider Demographics
NPI:1639219611
Name:CHOWDHRY, BASHIR A (MD)
Entity Type:Individual
Prefix:
First Name:BASHIR
Middle Name:A
Last Name:CHOWDHRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 S PECOS RD STE 10
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5027
Mailing Address - Country:US
Mailing Address - Phone:702-454-7311
Mailing Address - Fax:702-454-1197
Practice Address - Street 1:4160 S PECOS RD STE 10
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5027
Practice Address - Country:US
Practice Address - Phone:702-454-7311
Practice Address - Fax:702-454-1197
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3346174400000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002058Medicaid
NVC95881Medicare UPIN
NVV33WCGVW01Medicare ID - Type Unspecified